| NPI | 1770013948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2017019883) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019031204) |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2021-02-03 |