| NPI | 1700839024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: KY 8263) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 19026157) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: FL DN18772) | |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2017-03-22 |