| NPI | 1386979698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: IL 021.002322) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.027037) |
| Enumeration Date | 2009-10-05 |
| Last Update Date | 2011-04-11 |