| NPI | 1275741043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019-021311) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 51455) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2011-11-24 |