| NPI | 1740380591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019-026312) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 5679-015) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2007-07-08 |