| NPI | 1720789324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 111453) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019035695) |
| 122300000X Dentist (Licence: IN 12014503A) | |
| Enumeration Date | 2023-03-13 |
| Last Update Date | 2025-05-01 |