| NPI | 1669111217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.033780) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2022-06-01 |
| Last Update Date | 2023-10-25 |