| NPI | 1679752141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 6896356-9922) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019027012) |
| Enumeration Date | 2007-10-31 |
| Last Update Date | 2008-07-28 |