| NPI | 1174722839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019014602) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 016014602) |
| Enumeration Date | 2007-07-13 |
| Last Update Date | 2007-07-13 |