| NPI | 1477007110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: IL 019030800) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019030800) |
| 1223E0200X Dentist, Endodontics (Licence: TX 41299) | |
| Enumeration Date | 2016-08-11 |
| Last Update Date | 2025-04-16 |