| NPI | 1063902468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MD 18335) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.031520) |
| Enumeration Date | 2018-05-11 |
| Last Update Date | 2024-03-11 |