| NPI | 1578213161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019.033596) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 065321) |
| Enumeration Date | 2022-03-25 |
| Last Update Date | 2023-09-18 |