| NPI | 1699103689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: TX 31855) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019029431) |
| Enumeration Date | 2013-10-29 |
| Last Update Date | 2022-05-14 |