| NPI | 1982851531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019026207) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2007026095) |
| Enumeration Date | 2008-08-26 |
| Last Update Date | 2013-10-29 |