| NPI | 1306460845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223D0001X Dentist Dental Public Health (Licence: IL 019-032602) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: IL 019-032602) |
| Enumeration Date | 2020-06-01 |
| Last Update Date | 2020-07-22 |