| NPI | 1558865501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.031545) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN 12013467A) |
| Enumeration Date | 2018-03-22 |
| Last Update Date | 2020-08-16 |