| NPI | 1487046991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 1001205) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019030078) |
| Enumeration Date | 2015-02-21 |
| Last Update Date | 2017-04-12 |