| NPI | 1154487445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019028319) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE00010423) |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2010-06-23 |