| NPI | 1215344106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 1000959-15) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019029937) |
| Enumeration Date | 2014-07-13 |
| Last Update Date | 2014-07-13 |