| NPI | 1972592921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30.026350) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019-026154) |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2022-05-25 |