| NPI | 1043337694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ 10504) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019026521) |
| 122300000X Dentist (Licence: KY 7950) | |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2025-10-27 |