| NPI | 1235575739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019029409) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN 12012816A) |
| Enumeration Date | 2013-05-12 |
| Last Update Date | 2020-02-10 |