| NPI | 1497984157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 6604-15) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019028017) |
| Enumeration Date | 2009-07-02 |
| Last Update Date | 2026-07-02 |