| NPI | 1528137064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 6287-15) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019018687) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2013-12-03 |