| NPI | 1336838374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D012401) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019.034562) |
| Enumeration Date | 2023-05-04 |
| Last Update Date | 2025-03-27 |