| NPI | 1710974795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 021-002074) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019-026124) |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2009-05-27 |