| NPI | 1962790006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019030115) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE60448654) |
| Enumeration Date | 2011-07-11 |
| Last Update Date | 2024-10-16 |