| NPI | 1073709440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NM DD4932) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019-024309) |
| Enumeration Date | 2007-09-19 |
| Last Update Date | 2020-09-03 |