| NPI | 1891163150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.030385) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN 12012400A) |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: IL 019.030385) | |
| Enumeration Date | 2015-09-03 |
| Last Update Date | 2019-01-25 |