| NPI | 1700864543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: IA DDS-08288) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019027419) |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2015-05-10 |