| NPI | 1689073041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: IL 021.003070) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 9094724-9921) |
| 122300000X Dentist (Licence: WI 6001145-15) | |
| 1223G0001X Dentist, General Practice (Licence: IL 019.031524) | |
| Enumeration Date | 2014-08-21 |
| Last Update Date | 2024-01-22 |