| NPI | 1508205071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: IL 021002585) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019029346) |
| Enumeration Date | 2013-06-18 |
| Last Update Date | 2014-12-04 |