| NPI | 1689837825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 19-A-12900) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 23412-875) |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2022-11-18 |