| NPI | 1790710424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901020215) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.027072) |
| 122300000X Dentist (Licence: RI DEN 03060) | |
| 122300000X Dentist (Licence: MI 2901020215) | |
| 122300000X Dentist (Licence: TN 9118) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2024-04-11 |