| NPI | 1740850593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.033536) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN 12013665A) |
| Enumeration Date | 2021-06-24 |
| Last Update Date | 2022-08-22 |