| NPI | 1225357403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 0025873) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: IL 019028283) |
| Enumeration Date | 2010-05-26 |
| Last Update Date | 2013-01-14 |