| NPI | 1003161613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS039259) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019029123) |
| Enumeration Date | 2012-07-19 |
| Last Update Date | 2013-08-16 |