| NPI | 1164861324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12012016A) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019029457) |
| Enumeration Date | 2013-06-21 |
| Last Update Date | 2014-02-12 |