| NPI | 1689795957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 5598-15) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019-026371) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2025-08-13 |