| NPI | 1972918308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 19030435) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 1001717-15) |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2022-10-25 |