| NPI | 1104921279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 1002728) |
| Additional Taxonomies | 122300000X Dentist (Licence: NV 5053) |
| 122300000X Dentist (Licence: IL 019033030) | |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2023-05-02 |