| NPI | 1184714529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019.027814) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 6057-15) |
| 1223G0001X Dentist, General Practice (Licence: OH 2562-resident) | |
| Enumeration Date | 2006-10-14 |
| Last Update Date | 2010-09-09 |