| NPI | 1881199974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: AL D.007260-C) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2018018496) |
| 122300000X Dentist (Licence: FL DN28683) | |
| Enumeration Date | 2018-03-29 |
| Last Update Date | 2024-02-15 |