| NPI | 1184601973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 5974-15) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 19017817) |
| 1223G0001X Dentist, General Practice (Licence: IL 19017817) | |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2017-05-02 |