| NPI | 1346676145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 32138) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019029650) |
| Enumeration Date | 2013-09-25 |
| Last Update Date | 2017-05-01 |