| NPI | 1023370657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60665052) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019029038) |
| Enumeration Date | 2012-06-11 |
| Last Update Date | 2021-10-15 |