| NPI | 1508473349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 17865) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.032915) |
| 1223G0001X Dentist, General Practice (Licence: IL 019.032915) | |
| Enumeration Date | 2020-09-25 |
| Last Update Date | 2024-05-22 |