| NPI | 1790999399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MI 2901020341) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: IL 019026262) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2018-04-12 |