| NPI | 1336509900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 1001536-15) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.031386) |
| 122300000X Dentist (Licence: AZ 9614) | |
| 122300000X Dentist (Licence: TX 33401) | |
| Enumeration Date | 2016-02-25 |
| Last Update Date | 2019-10-01 |