| NPI | 1558921858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2019020053) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.032981) |
| Enumeration Date | 2019-06-18 |
| Last Update Date | 2024-05-02 |