| NPI | 1316788805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019035197) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 600153615) |
| Enumeration Date | 2024-06-06 |
| Last Update Date | 2025-03-18 |