| NPI | 1619237088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: IL 019031109) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DN1856206) |
| Enumeration Date | 2012-05-20 |
| Last Update Date | 2018-11-09 |