| NPI | 1871711408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: KY 670) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 7417) |
| 122300000X Dentist (Licence: IL 019.025255) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 021.001967) | |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2022-06-22 |