| NPI | 1295582906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.035723) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN10000053) |
| 122300000X Dentist (Licence: RI DEN03721) | |
| Enumeration Date | 2024-05-01 |
| Last Update Date | 2026-05-21 |