| 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 |