| NPI | 1952517708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019-020155) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 103421) |
| 1223G0001X Dentist, General Practice (Licence: VA 0401414197) | |
| 1223G0001X Dentist, General Practice (Licence: LA 6432) | |
| 1223G0001X Dentist, General Practice (Licence: NM DD3464) | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2019-08-19 |