| NPI | 1659942639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019034233) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 37595) |
| 1223G0001X Dentist, General Practice (Licence: FL 26064) | |
| Enumeration Date | 2021-07-09 |
| Last Update Date | 2023-09-15 |