| NPI | 1730361700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 13951) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019027366) |
| Enumeration Date | 2007-12-03 |
| Last Update Date | 2024-08-27 |