| NPI | 1285624171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WI 5127015) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: IL 025-001997) |
| 122300000X Dentist (Licence: IL 019-025019) | |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2011-11-14 |