| NPI | 1982726105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: WA 00033301) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019017049) |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2008-08-13 |