| NPI | 1871014001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MD 17615) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019031122) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: VA 0401416743) | |
| Enumeration Date | 2017-06-28 |
| Last Update Date | 2021-09-07 |