| NPI | 1508139635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019021144) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: IL 019021144) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: IL 019021144) | |
| Enumeration Date | 2012-02-21 |
| Last Update Date | 2012-02-21 |