| NPI | 1952808297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.031873) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.025463) |
| Enumeration Date | 2018-04-12 |
| Last Update Date | 2020-12-08 |