| NPI | 1134649312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.031296) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2017017251) |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2024-08-01 |