| NPI | 1811986250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN 13668) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019-023321) |
| Enumeration Date | 2005-10-18 |
| Last Update Date | 2022-06-24 |