| NPI | 1568024925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS042368) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL CA-DEN) |
| Enumeration Date | 2019-07-05 |
| Last Update Date | 2022-08-23 |