| NPI | 1194194431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.030304) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN015155) |
| Enumeration Date | 2015-09-16 |
| Last Update Date | 2018-03-17 |