| NPI | 1346372695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019016353) |
| 122300000X Dentist (Licence: IL 019-016353) | |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2021-02-23 |