| NPI | 1346364411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019-017066) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019-017066) |
| 1223G0001X Dentist, General Practice (Licence: WI 2604-015) | |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2021-04-21 |