| NPI | 1295864460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: AL 0107) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: KY 8357) |
| 122300000X Dentist (Licence: IL 019030477) | |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2015-11-18 |