| NPI | 1508177239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: IL 021002553) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2010018660) |
| Enumeration Date | 2010-06-28 |
| Last Update Date | 2019-06-28 |