| NPI | 1265801294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019.030588) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS040732) |
| 122300000X Dentist (Licence: MI 2901021704) | |
| 122300000X Dentist (Licence: FL DN21503) | |
| Enumeration Date | 2015-09-21 |
| Last Update Date | 2019-07-08 |