| 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 | 2025-05-28 |