| NPI | 1376301846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019036534) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN10000562) |
| Enumeration Date | 2024-03-11 |
| Last Update Date | 2026-03-03 |