| NPI | 1336558543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OK 7910) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019029993) |
| 122300000X Dentist (Licence: IL 319019139) | |
| 1223G0001X Dentist, General Practice (Licence: MO 2024009465) | |
| Enumeration Date | 2014-08-13 |
| Last Update Date | 2024-08-23 |