| NPI | 1699782854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D-3565) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL D-3565) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2015-11-09 |