| NPI | 1659431500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.022743) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 021.001638) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2007-07-16 |