| NPI | 1144775305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 021.003529) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN 10345) |
| Enumeration Date | 2016-08-17 |
| Last Update Date | 2026-07-27 |