| NPI | 1508412875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NV 7736) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019032340) |
| Enumeration Date | 2019-08-13 |
| Last Update Date | 2023-03-15 |