| NPI | 1992810188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D9034) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.027599) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2012-12-20 |