| NPI | 1871756130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019109418) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: MO 014578) |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2023-01-26 |