| NPI | 1689303091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: ID D-5420) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.033719) |
| Enumeration Date | 2022-06-09 |
| Last Update Date | 2025-01-03 |