| NPI | 1255403127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.014984) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 30290) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 021.000946) | |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2007-07-08 |