| NPI | 1306455654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019.033896) |
| Additional Taxonomies | 122300000X Dentist (Licence: LA 7091) |
| Enumeration Date | 2020-07-23 |
| Last Update Date | 2022-09-01 |