| NPI | 1518588649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN26802) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019.032655) |
| Enumeration Date | 2020-04-29 |
| Last Update Date | 2022-12-16 |