| NPI | 1700045523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901020356) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019027617) |
| Enumeration Date | 2008-06-06 |
| Last Update Date | 2016-11-02 |