| NPI | 1568752897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901020423) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 018001806) |
| Enumeration Date | 2011-04-07 |
| Last Update Date | 2016-01-19 |