| NPI | 1598194276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 021.001039) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.015444) |
| Enumeration Date | 2013-11-04 |
| Last Update Date | 2013-11-04 |