| NPI | 1053330928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: IL 019017893) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019017893) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2016-06-27 |