| NPI | 1144365321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN25571) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL DN25571) |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2024-01-09 |