| NPI | 1629068523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: VA 0401410983) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019026095) |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2019-10-09 |