| NPI | 1013155563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN30268) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 0190-25025) |
| Enumeration Date | 2009-01-21 |
| Last Update Date | 2025-11-05 |