| NPI | 1952958894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2952000706) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019.032983) |
| 1223G0001X Dentist, General Practice (Licence: MI 2901601502) | |
| Enumeration Date | 2019-08-26 |
| Last Update Date | 2022-10-08 |