| NPI | 1679730949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 021001842) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019023574) |
| Enumeration Date | 2008-05-22 |
| Last Update Date | 2008-05-22 |