| NPI | 1700528775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019035394) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH RES.004440) |
| Enumeration Date | 2022-04-11 |
| Last Update Date | 2024-07-23 |