| NPI | 1609456771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NC 13650) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: SC 10725) |
| 1223G0001X Dentist, General Practice (Licence: IL 019033126) | |
| Enumeration Date | 2021-04-12 |
| Last Update Date | 2026-07-08 |