| NPI | 1730262262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901017049) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019.0288153) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2018-04-25 |