| NPI | 1003705567 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 018.002310) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 018.002310) |
| Enumeration Date | 2025-06-30 |
| Last Update Date | 2025-06-30 |