| NPI | 1841632213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1856303) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019029570) |
| Enumeration Date | 2013-07-25 |
| Last Update Date | 2014-09-25 |