| NPI | 1558340398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 6272) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019-022250) |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2008-08-04 |