| NPI | 1740639772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: IL 021002952) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS040876) |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2019-11-15 |