| NPI | 1144669631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019030508) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ D008753) |
| Enumeration Date | 2013-06-18 |
| Last Update Date | 2015-11-30 |