| NPI | 1760510499 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 7119) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019.025077) |
| 1223G0001X Dentist, General Practice (Licence: NC 10444) | |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2025-01-27 |