| NPI | 1497903348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 10823) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019027750) |
| Enumeration Date | 2008-09-04 |
| Last Update Date | 2018-05-22 |