| NPI | 1023799558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 41409) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.035381) |
| 122300000X Dentist (Licence: GA DN123199) | |
| Enumeration Date | 2023-07-27 |
| Last Update Date | 2025-06-09 |