| NPI | 1497033013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019.028796) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IA 08842) |
| Enumeration Date | 2011-07-31 |
| Last Update Date | 2015-05-29 |