| NPI | 1720764764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2023026503) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019034408) |
| Enumeration Date | 2023-06-26 |
| Last Update Date | 2023-07-17 |