| NPI | 1598141095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1858321) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019030391) |
| 122300000X Dentist (Licence: VA 0401415462) | |
| Enumeration Date | 2015-08-06 |
| Last Update Date | 2021-01-06 |