| NPI | 1730274978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: KY 6298) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: IL 019018735) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2007-07-08 |