| NPI | 1245229939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 27349) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019023309) |
| Enumeration Date | 2005-10-17 |
| Last Update Date | 2011-12-05 |