| NPI | 1902229875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 062218-01) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.029705) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: PA DS043141) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 021.002621) | |
| Enumeration Date | 2014-01-29 |
| Last Update Date | 2023-09-28 |