| NPI | 1336818665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019033395) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901601119) |
| Enumeration Date | 2021-09-09 |
| Last Update Date | 2021-09-09 |