| NPI | 1215926613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ 6072) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019023643) |
| Enumeration Date | 2005-10-18 |
| Last Update Date | 2009-04-13 |