| NPI | 1952990681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019.033940) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: LA 7160) |
| 122300000X Dentist (Licence: LA 7160) | |
| Enumeration Date | 2021-01-17 |
| Last Update Date | 2022-08-22 |