| NPI | 1598207946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 33989) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019030845) |
| Enumeration Date | 2016-11-15 |
| Last Update Date | 2018-10-17 |