| NPI | 1740341601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12011189A) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019027025) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2017-02-01 |