| NPI | 1184990848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN20442) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 018001842) |
| Enumeration Date | 2012-03-27 |
| Last Update Date | 2014-09-15 |