| NPI | 1194379271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 36098) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.032253) |
| Enumeration Date | 2019-07-28 |
| Last Update Date | 2022-01-31 |