| NPI | 1487726097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 6068-15) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019-022389) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2015-05-11 |