| NPI | 1457615403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO DEN.00202153) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019.029288) |
| Enumeration Date | 2012-06-25 |
| Last Update Date | 2015-12-29 |