| NPI | 1205319274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 41249) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.031802) |
| 1223G0001X Dentist, General Practice (Licence: IL 019.031802) | |
| Enumeration Date | 2018-09-14 |
| Last Update Date | 2025-06-11 |