| NPI | 1164873204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 31926) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019031506) |
| Enumeration Date | 2016-06-30 |
| Last Update Date | 2020-07-21 |