| NPI | 1942561436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019.029361) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901020665) |
| Enumeration Date | 2012-05-31 |
| Last Update Date | 2021-10-25 |