| NPI | 1932494127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MT DEN-DEN-LIC-11558) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 7999864-8903) |
| Enumeration Date | 2011-06-15 |
| Last Update Date | 2016-07-22 |