| NPI | 1457837742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.031658) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO DEN.00204431) |
| Enumeration Date | 2018-07-19 |
| Last Update Date | 2020-07-23 |