| NPI | 1245587997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019029192) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IA 08978) |
| Enumeration Date | 2012-08-13 |
| Last Update Date | 2014-07-16 |