| NPI | 1922310234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019028698) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 018001772) |
| Enumeration Date | 2010-07-02 |
| Last Update Date | 2015-07-13 |