| NPI | 1992569081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 6001405) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019.035670) |
| Enumeration Date | 2024-02-08 |
| Last Update Date | 2025-11-12 |