| NPI | 1760908446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: GA DN122591) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 1001668) |
| 122300000X Dentist (Licence: IL 019.031991) | |
| 122300000X Dentist (Licence: VA 0401417077) | |
| 1223G0001X Dentist General Practice (Licence: WI 1001668) | |
| Enumeration Date | 2017-08-15 |
| Last Update Date | 2022-03-31 |