| NPI | 1538542279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN21721) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019030233) |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2016-05-21 |