| NPI | 1164580734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019027024) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO 9200) |
| 122300000X Dentist (Licence: IL 019027024) | |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2013-10-31 |