| NPI | 1245503168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.028578) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE60130362) |
| Enumeration Date | 2012-02-23 |
| Last Update Date | 2022-02-11 |