| NPI | 1083379010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 1002698-15) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019.033313) |
| Enumeration Date | 2021-11-04 |
| Last Update Date | 2021-11-04 |