| NPI | 1659346831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019-019108) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019.019108) |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2020-02-10 |