| NPI | 1609246701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019030470) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 65155) |
| Enumeration Date | 2015-10-01 |
| Last Update Date | 2021-09-27 |