| NPI | 1134142789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019.026484) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D8565) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2015-05-19 |