| NPI | 1588952980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 021002469) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: SC 6996) |
| 1223G0001X Dentist, General Practice (Licence: SC 6996) | |
| Enumeration Date | 2011-07-19 |
| Last Update Date | 2012-08-18 |