| NPI | 1164715785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.029381) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2013012559) |
| 1223G0001X Dentist, General Practice (Licence: TX 26184) | |
| 1223G0001X Dentist, General Practice (Licence: OK 7077) | |
| Enumeration Date | 2011-05-17 |
| Last Update Date | 2026-02-18 |