| NPI | 1427534429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WI 1001942) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019.031646) |
| Enumeration Date | 2018-07-13 |
| Last Update Date | 2025-06-05 |