| NPI | 1285037150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019030059) |
| Additional Taxonomies | 122300000X Dentist (Licence: IA DDS-09120) |
| Enumeration Date | 2014-10-06 |
| Last Update Date | 2014-10-06 |