| NPI | 1528027851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 19026993) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 052308) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2015-05-12 |