| NPI | 1831674589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2021042338) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019031895) |
| 1223G0001X Dentist, General Practice (Licence: CA DDS105941) | |
| Enumeration Date | 2018-09-28 |
| Last Update Date | 2021-11-18 |