| NPI | 1578697504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 19a15148) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: IL 021001289) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 021001200) | |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2013-05-29 |