| NPI | 1730792359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 600136815) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019032886) |
| Enumeration Date | 2020-08-24 |
| Last Update Date | 2023-11-06 |