| NPI | 1770159378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN123093) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019033106) |
| Enumeration Date | 2021-06-03 |
| Last Update Date | 2025-03-04 |