| NPI | 1841578671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: RI DEN03150) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019.028710) |
| 1223G0001X Dentist, General Practice (Licence: GA DN015319) | |
| Enumeration Date | 2011-07-27 |
| Last Update Date | 2017-04-28 |