| NPI | 1235346594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WA DE 10914) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 19026756) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2008-05-20 |