| NPI | 1699349118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2021017794) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019033253) |
| Enumeration Date | 2021-05-19 |
| Last Update Date | 2021-06-24 |