| NPI | 1275701146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WI 6002120) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 037164) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 021002928) | |
| Enumeration Date | 2008-02-13 |
| Last Update Date | 2026-05-05 |