| NPI | 1578972303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019029976) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019029976) |
| 1223G0001X Dentist, General Practice (Licence: IN 12012210A) | |
| Enumeration Date | 2014-08-06 |
| Last Update Date | 2019-11-24 |