| NPI | 1417077009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN29992) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019-023174) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2026-05-05 |