| NPI | 1366541211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: IL 019025501) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019-025501) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2015-05-28 |