| NPI | 1780052936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: IL 019.034077) |
| Additional Taxonomies | 122300000X Dentist (Licence: MP 0136) |
| Enumeration Date | 2015-09-04 |
| Last Update Date | 2025-06-05 |