| NPI | 1255652665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 021002666) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019.028331) |
| Enumeration Date | 2010-06-20 |
| Last Update Date | 2015-08-19 |