| NPI | 1497835557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 29538) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: IL 019-026491) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: WI 6584-15) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: IL 019026491) | |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2014-01-22 |