| NPI | 1245315092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 19-016941) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 28799) |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2013-10-24 |