| NPI | 1154595379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: KY 9844) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 56258) |
| 122300000X Dentist (Licence: IL 019028623) | |
| Enumeration Date | 2008-04-18 |
| Last Update Date | 2016-09-02 |