| NPI | 1093916231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019.017250) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.017250) |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2022-04-25 |