| NPI | 1093703746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: IL 019020328) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: TX 21533) |
| Enumeration Date | 2005-10-07 |
| Last Update Date | 2007-07-08 |