| NPI | 1053939298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 1002356-15) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.032638) |
| Enumeration Date | 2020-07-13 |
| Last Update Date | 2020-07-13 |