| NPI | 1699771345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 6623-015) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019-021598) |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2012-03-15 |