| NPI | 1124756408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.033920) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 6001045) |
| Enumeration Date | 2022-08-12 |
| Last Update Date | 2024-06-20 |