| NPI | 1104445808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 021.003333) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.032604) |
| Enumeration Date | 2020-04-13 |
| Last Update Date | 2024-07-29 |