| NPI | 1700975653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019025115) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019025115) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2025-02-21 |