| NPI | 1942649504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MT 5950) |
| Additional Taxonomies | 122300000X Dentist (Licence: MT DEN-DEN-LIC-5950) |
| Enumeration Date | 2013-06-17 |
| Last Update Date | 2017-10-27 |