| NPI | 1255810214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2021048524) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019031832) |
| Enumeration Date | 2018-08-10 |
| Last Update Date | 2022-02-16 |