NPI | 1316233554 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 021003297) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019.028602) |
Enumeration Date | 2011-06-27 |
Last Update Date | 2023-11-08 |