| NPI | 1003043274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: IL 036.055709) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 19.15068) |
| Enumeration Date | 2009-06-16 |
| Last Update Date | 2009-06-16 |