| NPI | 1104479724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019032826) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 35519) |
| Enumeration Date | 2019-07-23 |
| Last Update Date | 2020-11-17 |