| NPI | 1154483907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 021000899) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019014811) |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2020-04-07 |