| NPI | 1942652037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60810468) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.030854) |
| Enumeration Date | 2016-07-13 |
| Last Update Date | 2021-09-18 |