| NPI | 1245579499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 021.002996) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019029230) |
| 122300000X Dentist (Licence: MI 2901600326) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: IL 021.002987) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: MI 2901600326) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MI 2901600326) | |
| Enumeration Date | 2013-02-07 |
| Last Update Date | 2020-02-05 |