| NPI | 1336679521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019031177) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2017018517) |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2023-11-07 |