| NPI | 1104046689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: IL 019-018584) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: AZ 8079) |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2011-09-20 |