| NPI | 1093511784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: IL 019.035711) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: WA DE61007350) |
| Enumeration Date | 2025-02-22 |
| Last Update Date | 2025-02-22 |