| NPI | 1740775675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 1002487-15) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 10093) |
| 122300000X Dentist (Licence: IL 019.033566) | |
| Enumeration Date | 2018-06-23 |
| Last Update Date | 2023-08-08 |