| NPI | 1427348903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: IL 019.017653) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: IL 019.020212) |
| Enumeration Date | 2011-04-18 |
| Last Update Date | 2011-04-18 |