| NPI | 1013019629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN013168) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019.027312) |
| Enumeration Date | 2006-09-03 |
| Last Update Date | 2012-08-20 |