| NPI | 1063571974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.020118) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: IL 021.001401) |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2018-02-08 |