| NPI | 1295824456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ DO11476) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019021411) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2022-09-23 |