| NPI | 1346974581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: IL 019.033899) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019033899) |
| Enumeration Date | 2022-07-13 |
| Last Update Date | 2022-10-26 |