| NPI | 1992924427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2006007560) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019026823) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2008-07-08 |