| NPI | 1649225962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 19015994) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 19015994) |
| 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment | |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2024-06-19 |