| NPI | 1851341853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN17884) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: IL 019022444) |
| 1223P0300X Dentist, Periodontics (Licence: FL DN17884) | |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2014-11-10 |