| NPI | 1003031477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IA DDS-09357) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 1914975) |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2020-07-13 |