| NPI | 1841458379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN013844) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019027131) |
| Enumeration Date | 2008-05-31 |
| Last Update Date | 2013-03-06 |