| NPI | 1821688128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS043556) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019033092) |
| 122300000X Dentist (Licence: PA DS043556) | |
| Enumeration Date | 2021-01-20 |
| Last Update Date | 2022-07-18 |