| NPI | 1316197585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019028687) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 390200000X) |
| Enumeration Date | 2008-09-24 |
| Last Update Date | 2011-12-02 |