| NPI | 1033736087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2023014638) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.032714) |
| Enumeration Date | 2020-06-25 |
| Last Update Date | 2024-04-11 |