| NPI | 1669510202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019-023780) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019023780) |
| Enumeration Date | 2007-02-04 |
| Last Update Date | 2021-04-30 |