| NPI | 1962576967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.028496) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30-019566) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2015-01-26 |