| NPI | 1720300577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D9443) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019028121) |
| Enumeration Date | 2010-02-22 |
| Last Update Date | 2011-07-20 |