| NPI | 1366851610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019.029862) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IA 09134) |
| Enumeration Date | 2014-08-11 |
| Last Update Date | 2022-07-21 |