| NPI | 1326423872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 10299296-9922) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019030302) |
| 1223G0001X Dentist, General Practice (Licence: IL 019030302) | |
| Enumeration Date | 2015-07-27 |
| Last Update Date | 2019-06-10 |