| NPI | 1649641507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 19029769) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: IL 021.002719) |
| Enumeration Date | 2015-10-16 |
| Last Update Date | 2017-11-01 |