| NPI | 1376604678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.020711) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 021.001989) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2007-07-08 |