| NPI | 1184815169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: KY 9003) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019027473) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: MO 2008036620) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: IL 021002548) | |
| Enumeration Date | 2007-08-06 |
| Last Update Date | 2014-10-22 |