| NPI | 1184159550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 021002803) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019030121) |
| 122300000X Dentist (Licence: NY 058997) | |
| 122300000X Dentist (Licence: TX 32674) | |
| Enumeration Date | 2017-04-24 |
| Last Update Date | 2017-04-24 |