| NPI | 1285869081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MN D13648) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019027932) |
| Enumeration Date | 2009-05-21 |
| Last Update Date | 2017-02-13 |