| NPI | 1770632366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: GA 13688) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019-027231) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2010-11-04 |