| NPI | 1083929475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.029667) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 62834) |
| Enumeration Date | 2010-08-10 |
| Last Update Date | 2013-11-22 |