| NPI | 1881074425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN26702) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.030289) |
| Enumeration Date | 2015-06-08 |
| Last Update Date | 2023-12-26 |