| NPI | 1437277019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.018193) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019018193) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2012-06-28 |