| NPI | 1366772287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 019.032870) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO 8923) |
| 122300000X Dentist (Licence: AR 3740) | |
| Enumeration Date | 2009-12-29 |
| Last Update Date | 2021-09-08 |