| NPI | 1922622943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401417365) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019032613) |
| Enumeration Date | 2020-06-05 |
| Last Update Date | 2022-11-02 |