| NPI | 1821071804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: WI 5774-15) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: IL 019026610) |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2022-07-21 |