| NPI | 1609023977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.027241) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2007006450) |
| Enumeration Date | 2008-08-19 |
| Last Update Date | 2014-10-15 |