| NPI | 1851771703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 1001127-15) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.030546) |
| 1223E0200X Dentist, Endodontics (Licence: IL 021.003011) | |
| Enumeration Date | 2015-06-05 |
| Last Update Date | 2021-10-28 |