| NPI | 1063693315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: IL 021.002068) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 6091-15) |
| Enumeration Date | 2007-11-15 |
| Last Update Date | 2007-11-15 |