| NPI | 1861780074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: PA DS039007) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: IL 019028781) |
| Enumeration Date | 2011-07-21 |
| Last Update Date | 2016-02-16 |