| NPI | 1376730200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: IL 019-027507) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NM DD3375) |
| Enumeration Date | 2007-09-25 |
| Last Update Date | 2022-03-14 |