| NPI | 1992091862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2016009847) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019028637) |
| 122300000X Dentist (Licence: TN DS0000009522) | |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2021-05-25 |