| NPI | 1891342127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN24586) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019.032347) |
| Enumeration Date | 2019-08-21 |
| Last Update Date | 2021-01-25 |