| NPI | 1174972202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: IL 019.031720) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN 12012518A) |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2023-03-02 |