| NPI | 1427548833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019032065) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.025427) |
| Enumeration Date | 2018-05-11 |
| Last Update Date | 2025-10-22 |