| NPI | 1164424016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019024670) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2005002250) |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2021-07-02 |