| NPI | 1962070417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019.033365) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401417436) |
| Enumeration Date | 2021-06-11 |
| Last Update Date | 2021-08-04 |