| NPI | 1790138774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL DN24566) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019030822) |
| Enumeration Date | 2016-07-14 |
| Last Update Date | 2026-07-26 |