| NPI | 1679556500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019-017911) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 5227-015) |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2007-07-08 |