| NPI | 1659880318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MA DN1857831) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019031412) |
| 122300000X Dentist (Licence: MA DN1857831) | |
| 1223G0001X Dentist, General Practice (Licence: MA DN1857831) | |
| 1223G0001X Dentist, General Practice (Licence: IL 019031412) | |
| Enumeration Date | 2017-09-26 |
| Last Update Date | 2025-03-26 |