| NPI | 1942043146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 6001600-15) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.035179) |
| Enumeration Date | 2024-06-15 |
| Last Update Date | 2024-08-14 |