| NPI | 1750802641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 33876) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019031183) |
| Enumeration Date | 2017-06-29 |
| Last Update Date | 2018-08-13 |