| NPI | 1972865491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019030102) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2012017871) |
| Enumeration Date | 2012-06-11 |
| Last Update Date | 2018-01-31 |