| NPI | 1982125068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901022388) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: IL 019.031087) |
| Enumeration Date | 2017-06-29 |
| Last Update Date | 2024-07-01 |