| NPI | 1902119837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.028399) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: IL 021002781) |
| Enumeration Date | 2010-07-20 |
| Last Update Date | 2016-12-09 |