| NPI | 1265405989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019017429) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 40833) |
| 1223G0001X Dentist, General Practice (Licence: WI 3411) | |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2013-04-03 |