| NPI | 1164787230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 34820) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019029106) |
| 122300000X Dentist (Licence: WI 1001461) | |
| Enumeration Date | 2012-07-05 |
| Last Update Date | 2025-09-02 |