| NPI | 1912711912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 319.025168) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KY 11278) |
| Enumeration Date | 2025-02-03 |
| Last Update Date | 2026-04-16 |