| NPI | 1730243056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: IL 021001002) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: IL 019014048) |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2009-09-23 |