| NPI | 1386096907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 021.002760) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.030641) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CT 2.011249) | |
| Enumeration Date | 2016-07-07 |
| Last Update Date | 2017-02-09 |