| NPI | 1851772701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS040468) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 1001106-15) |
| 1223G0001X Dentist, General Practice (Licence: IL 019030327) | |
| Enumeration Date | 2015-06-17 |
| Last Update Date | 2016-02-12 |