| NPI | 1760902878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 107951) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019031292) |
| 122300000X Dentist (Licence: IN 1201325A) | |
| 122300000X Dentist (Licence: NY 061656) | |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2022-10-05 |