| NPI | 1063546109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019032494) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS KS5585) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2020-08-07 |