| NPI | 1316960768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2000157897) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019028574) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2016-08-17 |