| NPI | 1871741454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MO 2013025512) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: IL 019-027747) |
| Enumeration Date | 2008-09-08 |
| Last Update Date | 2021-12-21 |