NPI | 1104946912 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: WI 5281-015) |
Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: IL 19-025556) |
Enumeration Date | 2007-03-29 |
Last Update Date | 2014-02-24 |