| NPI | 1922177211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: KS 61093) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: IL 021001478) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2016-10-05 |