| NPI | 1013584572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: IL 019.034668) |
| Additional Taxonomies | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: WI 6002025-15) |
| 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: CO DEN.00205942) | |
| Enumeration Date | 2021-06-04 |
| Last Update Date | 2026-02-11 |