| NPI | 1609808963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 016077) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019-025271) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2011-09-30 |