| NPI | 1386741858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ D5550) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019025258) |
| 122300000X Dentist (Licence: MN D11625) | |
| Enumeration Date | 2006-09-19 |
| Last Update Date | 2012-10-05 |