| NPI | 1962529859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: FL DN0013475) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: IL 019023348) |
| 1223G0001X Dentist General Practice (Licence: DC DEN5598) | |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2023-03-07 |