| NPI | 1407103658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 021002461) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.028279) |
| Enumeration Date | 2012-08-07 |
| Last Update Date | 2012-08-09 |