| NPI | 1841613049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MT DEN-DEN-LIC-6079) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID D-5203) |
| 1223G0001X Dentist, General Practice (Licence: IA DDS-09864) | |
| 1223G0001X Dentist, General Practice (Licence: WI 1002437) | |
| Enumeration Date | 2014-01-24 |
| Last Update Date | 2021-07-23 |