| NPI | 1760621163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.022915) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019022915) |
| Enumeration Date | 2009-02-10 |
| Last Update Date | 2023-10-30 |