| NPI | 1386995223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: OR D10090) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.029277) |
| Enumeration Date | 2012-10-01 |
| Last Update Date | 2015-04-09 |