| NPI | 1982113130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 1001894-15) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019.031305) |
| 1223G0001X Dentist, General Practice (Licence: IL 018.002052) | |
| Enumeration Date | 2017-09-20 |
| Last Update Date | 2021-02-28 |