| NPI | 1306012596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: IL 021000831) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019014434) |
| Enumeration Date | 2008-05-07 |
| Last Update Date | 2008-05-07 |