| NPI | 1053590331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA DN013750) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.027117) |
| Enumeration Date | 2007-11-02 |
| Last Update Date | 2015-05-15 |