| NPI | 1861582553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019-024214) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.021488) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2007-07-08 |