| NPI | 1467425389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 23811) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019-026245) |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2011-05-16 |