| NPI | 1871856617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 021002650) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.028872) |
| 122300000X Dentist (Licence: DC DEN1000944) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WI 6916-15) | |
| Enumeration Date | 2012-06-18 |
| Last Update Date | 2015-05-07 |