| NPI | 1104846609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: IL 02101463) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019-020579) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2008-07-21 |