| NPI | 1063620334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 19-026273) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 049649) |
| Enumeration Date | 2007-05-19 |
| Last Update Date | 2023-01-13 |