| NPI | 1639300585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019.028081) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IA 08662) |
| Enumeration Date | 2009-07-27 |
| Last Update Date | 2016-01-29 |