| NPI | 1962816603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: IL 019030597) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: PA DS039810) |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2023-03-10 |