| NPI | 1083457709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2024021020) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019035192) |
| Enumeration Date | 2024-06-18 |
| Last Update Date | 2024-06-18 |