| NPI | 1730818295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019033742) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2022021915) |
| Enumeration Date | 2022-06-08 |
| Last Update Date | 2022-09-10 |