| NPI | 1538153440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IA 06868) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019-018993) |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2024-01-11 |