| NPI | 1033735089 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: IL 021.003328) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.032728) |
| Enumeration Date | 2020-06-24 |
| Last Update Date | 2024-08-09 |