| NPI | 1063895357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019.032385) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 10056) |
| Enumeration Date | 2015-07-04 |
| Last Update Date | 2019-10-07 |