| NPI | 1730314097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 021.002259) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.027450) |
| Enumeration Date | 2009-05-15 |
| Last Update Date | 2013-01-02 |