| NPI | 1285283671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE61080623) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019032387) |
| Enumeration Date | 2019-09-09 |
| Last Update Date | 2021-02-12 |