| NPI | 1548428998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019027676) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901019781) |
| Enumeration Date | 2008-05-31 |
| Last Update Date | 2019-06-19 |