| NPI | 1518530435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN28132) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019.033252) |
| Enumeration Date | 2021-07-19 |
| Last Update Date | 2023-11-27 |