| NPI | 1205771300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019.036962) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 6002072-15) |
| Enumeration Date | 2026-04-23 |
| Last Update Date | 2026-04-23 |