| NPI | 1942641238 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 41773) | 
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019029503) | 
| Enumeration Date | 2013-07-15 | 
| Last Update Date | 2025-07-11 |