| NPI | 1962178558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.033393) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN 12013700A) |
| Enumeration Date | 2021-08-23 |
| Last Update Date | 2023-05-03 |