| NPI | 1053833509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019035976) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN 10600) |
| Enumeration Date | 2017-07-16 |
| Last Update Date | 2025-05-23 |