| NPI | 1689719320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MT 2284) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 1122957) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2016-01-07 |