| NPI | 1003187956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019030941) |
| Additional Taxonomies | 122300000X Dentist (Licence: NM DD4038) |
| Enumeration Date | 2012-01-24 |
| Last Update Date | 2017-03-02 |