| NPI | 1912221763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IL 091001682) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 091001682) |
| Enumeration Date | 2010-03-23 |
| Last Update Date | 2010-03-23 |