| NPI | 1639609340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019.031156) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA DN015511) |
| Enumeration Date | 2017-06-14 |
| Last Update Date | 2024-03-03 |