| NPI | 1386124675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 17958) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019.031999) |
| 1223G0001X Dentist, General Practice (Licence: PA DS044870) | |
| 1223G0001X Dentist, General Practice (Licence: OH 30.026964) | |
| Enumeration Date | 2018-08-16 |
| Last Update Date | 2025-02-11 |