| NPI | 1063760080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.029195) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019.029195) |
| Enumeration Date | 2012-08-23 |
| Last Update Date | 2024-04-21 |