| NPI | 1972573624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019-026064) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401008558) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2013-02-27 |