| NPI | 1962841601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: IL 021002978) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019029440) |
| 1223G0001X Dentist, General Practice (Licence: AZ 9279) | |
| Enumeration Date | 2013-06-16 |
| Last Update Date | 2019-09-03 |