| NPI | 1164820544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: IL 021002001) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019025012) |
| Enumeration Date | 2014-12-16 |
| Last Update Date | 2022-04-12 |