| NPI | 1407867252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MT 2112) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019-025870) |
| 1223G0001X Dentist, General Practice (Licence: MO 2002015202) | |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2007-07-08 |