| NPI | 1225476088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO 00203107) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019029425) |
| Enumeration Date | 2013-06-13 |
| Last Update Date | 2017-12-11 |