| NPI | 1508218751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: IL 019.032209) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.032209) |
| Enumeration Date | 2016-07-11 |
| Last Update Date | 2019-07-15 |