| NPI | 1043669419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019030653) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901021942) |
| Enumeration Date | 2016-06-07 |
| Last Update Date | 2021-05-10 |