| NPI | 1134680101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.036904) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 1002162-15) |
| Enumeration Date | 2019-03-30 |
| Last Update Date | 2026-03-20 |