| NPI | 1821071804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: WI 5774-15) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 5774-15) |
| 1223G0001X Dentist, General Practice (Licence: IL 019026610) | |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2025-07-17 |