| NPI | 1972288934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.035521) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1860028) |
| Enumeration Date | 2023-06-19 |
| Last Update Date | 2025-03-28 |