| NPI | 1043674021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 021.003043) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.031525) |
| Enumeration Date | 2016-04-06 |
| Last Update Date | 2024-05-02 |