| NPI | 1235659723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019.031229) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IN 12012791A) |
| Enumeration Date | 2017-06-26 |
| Last Update Date | 2021-01-15 |