| NPI | 1760698765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.016832) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: IL 021-001178) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2021-11-04 |