| NPI | 1811542475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2019043422) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019032330) |
| Enumeration Date | 2019-08-09 |
| Last Update Date | 2024-03-28 |