| NPI | 1972156123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019.032136) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN24358) |
| Enumeration Date | 2019-07-17 |
| Last Update Date | 2019-07-17 |