| NPI | 1689982852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.028517) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NV 5832) |
| 1223G0001X Dentist General Practice (Licence: MT 2371) | |
| Enumeration Date | 2010-09-21 |
| Last Update Date | 2016-06-06 |