| NPI | 1740691393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 34604) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019029892) |
| Enumeration Date | 2014-05-16 |
| Last Update Date | 2020-07-30 |