| NPI | 1578628418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MO 2000174326) |
| Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: IL 019025212) |
| 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: MO 2000174326) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: IL 019025212) | |
| Enumeration Date | 2006-12-22 |
| Last Update Date | 2021-02-05 |