| NPI | 1366512105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: IL 019015963) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: IL 19A15967) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2023-07-24 |