| NPI | 1932817491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2024028457) |
| Additional Taxonomies | 122300000X Dentist (Licence: KS 62174) |
| 122300000X Dentist (Licence: IL 019.033785) | |
| Enumeration Date | 2022-11-14 |
| Last Update Date | 2024-07-25 |