| NPI | 1205459153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN28261) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019.032582) |
| Enumeration Date | 2020-05-27 |
| Last Update Date | 2024-06-12 |