| NPI | 1033473764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 021.002680) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.029082) |
| Enumeration Date | 2012-06-27 |
| Last Update Date | 2020-08-19 |