| NPI | 1831529270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901022064) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019-0017001) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: IL 019-001418) | |
| Enumeration Date | 2013-11-21 |
| Last Update Date | 2021-09-30 |