| NPI | 1023354388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 019.029011) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019029011) |
| Enumeration Date | 2012-12-13 |
| Last Update Date | 2023-07-28 |