| NPI | 1164862553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 13490263-9923) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019029495) |
| 122300000X Dentist (Licence: UT 13490263-8903) | |
| Enumeration Date | 2013-06-28 |
| Last Update Date | 2023-09-20 |