| NPI | 1154395994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 26448) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 19027136) |
| Enumeration Date | 2006-02-16 |
| Last Update Date | 2014-05-16 |