| NPI | 1275141764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MO 2020022768) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2020022768) |
| 122300000X Dentist (Licence: IL 019.032823) | |
| Enumeration Date | 2020-07-21 |
| Last Update Date | 2023-09-05 |