| NPI | 1124689765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401416674) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019.032193) |
| Enumeration Date | 2019-06-25 |
| Last Update Date | 2021-10-27 |