| NPI | 1720952070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901602731) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019036464) |
| Enumeration Date | 2025-09-30 |
| Last Update Date | 2025-09-30 |