| NPI | 1235360595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 9082) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 018001733) |
| 1223G0001X Dentist, General Practice (Licence: IL 019.028164) | |
| 1223G0001X Dentist, General Practice (Licence: FL DN22426) | |
| Enumeration Date | 2009-08-05 |
| Last Update Date | 2019-04-08 |