| NPI | 1134381171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 25116) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019.027618) |
| 1223G0001X Dentist, General Practice (Licence: TX 25116) | |
| Enumeration Date | 2008-07-01 |
| Last Update Date | 2023-05-15 |