| NPI | 1356696363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 28550) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.029125) |
| Enumeration Date | 2012-07-16 |
| Last Update Date | 2013-01-28 |