| NPI | 1609955798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019018482) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN 12008917A) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2026-01-09 |