| NPI | 1689888315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 021.002290) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901019094) |
| 1223G0001X Dentist, General Practice (Licence: MI 2901019094) | |
| 122300000X Dentist (Licence: IL 019.027309) | |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2012-03-27 |