| NPI | 1871717868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 38298) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019029736) |
| 122300000X Dentist (Licence: CA 50690) | |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2022-04-11 |