| NPI | 1568824803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901021873) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019030697) |
| Enumeration Date | 2016-03-25 |
| Last Update Date | 2021-06-02 |