| NPI | 1457834723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 031929) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN23737) |
| Enumeration Date | 2018-09-12 |
| Last Update Date | 2020-06-23 |