| NPI | 1558055608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019035293) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901601790) |
| Enumeration Date | 2023-06-02 |
| Last Update Date | 2025-05-21 |