| NPI | 1376738245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019027477) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 28744) |
| Enumeration Date | 2007-09-13 |
| Last Update Date | 2022-01-28 |