| NPI | 1659524122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019028313) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2010016964) |
| 122300000X Dentist (Licence: OH 30-022854) | |
| Enumeration Date | 2008-10-28 |
| Last Update Date | 2023-02-06 |