| NPI | 1982693099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WI 4214-015) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019-021052) |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2008-07-31 |