| NPI | 1295276541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019031138) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL have not received) |
| Enumeration Date | 2017-03-19 |
| Last Update Date | 2022-07-21 |