| NPI | 1295998383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1855047) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019027733) |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2009-05-14 |