| NPI | 1922739648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901602779) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.033824) |
| Enumeration Date | 2022-06-22 |
| Last Update Date | 2025-07-30 |