| NPI | 1407915291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 1001483) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019025511) |
| Enumeration Date | 2006-12-07 |
| Last Update Date | 2017-04-14 |