| NPI | 1346364403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 30181) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 30181) |
| 1223G0001X Dentist, General Practice (Licence: IL 19027201) | |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2019-08-14 |