| NPI | 1164508594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: IL 021001799) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019023414) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2007-10-09 |