| NPI | 1730174590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: KS 61135) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019-026760) |
| 122300000X Dentist (Licence: NE 7054) | |
| Enumeration Date | 2005-09-16 |
| Last Update Date | 2017-03-01 |