| NPI | 1285013664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.035891) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.024444) |
| Enumeration Date | 2015-05-19 |
| Last Update Date | 2025-04-28 |