| NPI | 1174971808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 1001220-15) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019030495) |
| Enumeration Date | 2016-06-03 |
| Last Update Date | 2016-06-03 |