| NPI | 1700771086 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 018.012623) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 14231) |
| Enumeration Date | 2025-06-09 |
| Last Update Date | 2026-07-07 |