| NPI | 1487818720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30.022887) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019027738) |
| Enumeration Date | 2008-07-16 |
| Last Update Date | 2011-02-01 |