| NPI | 1003987645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 019026910) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OH 30021689) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: OH 35085671) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: IL 036115703) | |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2022-08-23 |