| NPI | 1417235524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019028820) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN014322) |
| 122300000X Dentist (Licence: AL 5864 C1) | |
| Enumeration Date | 2011-07-25 |
| Last Update Date | 2015-09-14 |