| NPI | 1194089821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1856486) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019029092) |
| Enumeration Date | 2012-06-27 |
| Last Update Date | 2020-01-10 |