| NPI | 1700866241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019-019249) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE00008689) |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2016-07-08 |