| NPI | 1508067315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN9500090) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019026482) |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2024-05-14 |