| NPI | 1295140705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 19030477) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2014019418) |
| Enumeration Date | 2014-06-23 |
| Last Update Date | 2015-10-05 |