| NPI | 1407296718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401414771) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401414771) |
| 122300000X Dentist (Licence: IL 019029496) | |
| Enumeration Date | 2013-07-01 |
| Last Update Date | 2018-06-19 |