| NPI | 1699887364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 0528351) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019027807) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2014-03-24 |