| NPI | 1033204243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NV S7-102) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV 4164) |
| 1223G0001X Dentist, General Practice (Licence: IL 019-019555) | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2018-11-01 |