| NPI | 1427882760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.036458) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 6001667) |
| Enumeration Date | 2024-08-29 |
| Last Update Date | 2025-08-27 |