| NPI | 1255714747 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA 1857402) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 100114915) |
| Enumeration Date | 2015-07-02 |
| Last Update Date | 2020-02-25 |