| NPI | 1215224456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 33337) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019028744) |
| Enumeration Date | 2011-07-08 |
| Last Update Date | 2022-03-24 |