| NPI | 1669761656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN014444) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019028343) |
| Enumeration Date | 2011-03-31 |
| Last Update Date | 2012-09-13 |