| NPI | 1003461849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.033426) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DL14112) |
| Enumeration Date | 2019-08-08 |
| Last Update Date | 2022-03-24 |