| NPI | 1679886295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019.029337) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DN1855365) |
| Enumeration Date | 2010-07-24 |
| Last Update Date | 2013-07-26 |