| NPI | 1134261951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: IL 021001185) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019016282) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2008-07-15 |