| NPI | 1396255097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 021002849) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019031410) |
| 1223G0001X Dentist, General Practice (Licence: IL 019031410) | |
| Enumeration Date | 2017-10-07 |
| Last Update Date | 2017-12-07 |