| NPI | 1740766609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 00347) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019031781) |
| Enumeration Date | 2018-07-13 |
| Last Update Date | 2019-10-21 |