| NPI | 1255648812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KS 60737) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019-028278) |
| Enumeration Date | 2010-09-02 |
| Last Update Date | 2010-09-02 |