| NPI | 1225461247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WI 1002348) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.029572) |
| Enumeration Date | 2013-08-13 |
| Last Update Date | 2022-04-28 |