| NPI | 1376953000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IA DDS-10400) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 100123715) |
| 122300000X Dentist (Licence: IL 019029754) | |
| Enumeration Date | 2014-05-02 |
| Last Update Date | 2026-02-09 |