| NPI | 1023015401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019-019499) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 004212) |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2015-12-18 |