| NPI | 1487708574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.011686) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: IL 021.000412) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2007-07-08 |