| NPI | 1972618692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE60227308) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019025513) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2011-09-23 |