| NPI | 1689102667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 1001540-15) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019-031096) |
| Enumeration Date | 2017-06-02 |
| Last Update Date | 2018-03-17 |