| NPI | 1841630126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MT DEN-DEN-LIC-9683) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 61020) |
| Enumeration Date | 2013-07-01 |
| Last Update Date | 2021-09-16 |