| NPI | 1073655213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019017944) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D5494) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2021-02-10 |