| NPI | 1194879098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.021691) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: IL 021.001797) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2007-07-08 |