| NPI | 1518961390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 1002044-15) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 19-17529) |
| 1223G0001X Dentist, General Practice (Licence: AZ D008268) | |
| 1223G0001X Dentist, General Practice (Licence: MI 2901013064) | |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2023-02-28 |