| NPI | 1215978655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 35977) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019025594) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2021-02-20 |