| NPI | 1194981092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019019620) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: IL 019019620) |
| 1223G0001X Dentist, General Practice (Licence: IL 019019620) | |
| Enumeration Date | 2008-07-31 |
| Last Update Date | 2024-08-20 |