| NPI | 1396916649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: IL 021.002357) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.027.427) |
| Enumeration Date | 2008-03-14 |
| Last Update Date | 2012-10-17 |