| NPI | 1447521810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2013016294) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019028696) |
| Enumeration Date | 2012-01-18 |
| Last Update Date | 2024-09-24 |