| NPI | 1114535457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019.032764) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2020021490) |
| Enumeration Date | 2020-07-22 |
| Last Update Date | 2024-08-12 |