| NPI | 1821982216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 600184015) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019036085) |
| Enumeration Date | 2025-06-09 |
| Last Update Date | 2025-06-10 |