| NPI | 1881687325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 19022715) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: IL 21001719) |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2007-07-08 |