| NPI | 1902024706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AL 5408) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019027230) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2012-07-25 |