| NPI | 1477606234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: IL 019026750) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: WI 6639) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2023-05-16 |