| NPI | 1902951122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MT DEN-DEN-LIC-2150) |
| Additional Taxonomies | 122300000X Dentist (Licence: MT 2150) |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2025-04-28 |