| NPI | 1366641805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019016989) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019-016989) |
| Enumeration Date | 2007-07-15 |
| Last Update Date | 2007-07-15 |