| NPI | 1588764450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: IL 319003750) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: IL 021000838) |
| 1223P0300X Dentist, Periodontics (Licence: IL 019013603) | |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2007-07-08 |