| NPI | 1366002289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019.033460) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901600179) |
| Enumeration Date | 2019-06-13 |
| Last Update Date | 2025-06-26 |