| NPI | 1023246451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.017141) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019-017141) |
| 122300000X Dentist (Licence: IL 319-006779) | |
| 122300000X Dentist (Licence: IL 319.006779) | |
| Enumeration Date | 2009-06-24 |
| Last Update Date | 2016-05-03 |