| NPI | 1659455772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DF11247) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 136-000107) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2017-03-30 |