| NPI | 1265814990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 31915) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019-030178) |
| Enumeration Date | 2015-06-18 |
| Last Update Date | 2016-07-12 |