| NPI | 1275525347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ 7177) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019-026237) |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2008-01-30 |