| NPI | 1306264163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 021002678) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019029451) |
| Enumeration Date | 2014-03-30 |
| Last Update Date | 2016-03-08 |