| NPI | 1457616385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: WI 7187) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: IL 019029167) |
| Enumeration Date | 2012-07-06 |
| Last Update Date | 2018-05-03 |