| NPI | 1497366603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2021000610) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019032867) |
| Enumeration Date | 2020-08-11 |
| Last Update Date | 2023-06-30 |