| NPI | 1891771366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN013704) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 19026680) |
| 1223G0001X Dentist, General Practice (Licence: SC 4249) | |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2012-05-01 |