| NPI | 1669916078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ 9625) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019.030980) |
| Enumeration Date | 2016-12-05 |
| Last Update Date | 2016-12-27 |