| NPI | 1689743247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 021.001948) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019024635) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2009-08-11 |