| NPI | 1841712536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: IL 019031336) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TX 33277) |
| Enumeration Date | 2017-07-13 |
| Last Update Date | 2020-10-05 |