| NPI | 1598768129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019-026320) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 5538443-9921/8903) |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2010-03-25 |