| NPI | 1790787695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 8348) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019027483) |
| 1223G0001X Dentist, General Practice (Licence: PA DS036291) | |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2011-09-07 |