| NPI | 1487977765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: IL 021.002462) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.028264) |
| Enumeration Date | 2010-03-01 |
| Last Update Date | 2022-07-05 |