| NPI | 1790853307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019023562) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 021001795) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2007-07-08 |