| NPI | 1538430590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: IL 021002903) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.030426) |
| Enumeration Date | 2012-01-23 |
| Last Update Date | 2019-10-24 |