| 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 |