| NPI | 1245451749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019026198) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: MO 2006016236) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2007-07-08 |