| NPI | 1588797682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019-025051) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019025051) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2008-03-28 |