| NPI | 1790327336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.032394) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN 12013271A) |
| 122300000X Dentist (Licence: WI 1002223-15) | |
| Enumeration Date | 2019-10-15 |
| Last Update Date | 2020-09-23 |