| NPI | 1821467622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12012391A) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019030309) |
| Enumeration Date | 2015-09-22 |
| Last Update Date | 2020-11-26 |