| NPI | 1477780633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019027166) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2009014660) |
| Enumeration Date | 2009-06-16 |
| Last Update Date | 2013-02-15 |