| NPI | 1215211685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30.024163) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019.028649) |
| 1223G0001X Dentist, General Practice (Licence: IL 019028649) | |
| Enumeration Date | 2011-10-04 |
| Last Update Date | 2019-09-18 |