| NPI | 1750693149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901020331) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.028405) |
| Enumeration Date | 2010-07-14 |
| Last Update Date | 2011-09-08 |