| NPI | 1811209786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NM DD4151) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019028372) |
| Enumeration Date | 2010-07-08 |
| Last Update Date | 2026-03-25 |