| NPI | 1083068928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 021002745) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019030331) |
| Enumeration Date | 2016-04-18 |
| Last Update Date | 2016-07-28 |