| NPI | 1861163107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2024005969) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.033408) |
| Enumeration Date | 2021-09-27 |
| Last Update Date | 2024-07-24 |