| NPI | 1730243213 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: IL 021002186) | 
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019025826) | 
| Enumeration Date | 2006-12-20 | 
| Last Update Date | 2010-03-09 |