| NPI | 1427180041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 29650) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019020104) |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2015-08-13 |