| NPI | 1710267075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: WA DE60455178) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019028835) |
| Enumeration Date | 2011-08-18 |
| Last Update Date | 2018-09-04 |