| NPI | 1043704075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 35817) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019.031693) |
| Enumeration Date | 2018-06-22 |
| Last Update Date | 2020-06-29 |