| NPI | 1427822147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 6001735) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019.034663) |
| Enumeration Date | 2023-11-13 |
| Last Update Date | 2026-03-08 |