| NPI | 1811882194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2025020493) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019.036393) |
| Enumeration Date | 2025-06-09 |
| Last Update Date | 2025-08-15 |