| NPI | 1891314118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE61377821) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.032841) |
| Enumeration Date | 2020-04-16 |
| Last Update Date | 2023-03-29 |