| NPI | 1023546777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019.032804) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02679300) |
| Enumeration Date | 2017-05-25 |
| Last Update Date | 2021-01-01 |