| NPI | 1700452729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.033080) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901601986) |
| Enumeration Date | 2021-06-01 |
| Last Update Date | 2024-10-14 |