| NPI | 1508350257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: IL 019.031721) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019031721) |
| Enumeration Date | 2018-06-17 |
| Last Update Date | 2019-12-04 |