| NPI | 1316040991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019012566) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 015550) |
| 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: IL 021000746) | |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2007-07-08 |