| NPI | 1306007703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 6276-15) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019027647) |
| Enumeration Date | 2008-06-19 |
| Last Update Date | 2008-07-01 |