| NPI | 1811336647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019.032363) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 1001277) |
| 1223G0001X Dentist, General Practice (Licence: CA 62440) | |
| Enumeration Date | 2013-06-14 |
| Last Update Date | 2021-09-02 |