| NPI | 1730479361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 6706-15) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019028686) |
| Enumeration Date | 2011-04-16 |
| Last Update Date | 2015-01-09 |