| NPI | 1538519368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019030975) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 1001335-15) |
| Enumeration Date | 2016-06-13 |
| Last Update Date | 2023-08-09 |