| NPI | 1033277934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: IL 19A14070) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: CA 56670) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2008-02-27 |