| NPI | 1669994232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.031429) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL 22897) |
| 1223G0001X Dentist, General Practice (Licence: IL 019.031429) | |
| 1223G0001X Dentist, General Practice (Licence: FL 22897) | |
| Enumeration Date | 2017-07-14 |
| Last Update Date | 2019-04-21 |