| NPI | 1134525967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MI 2901022843) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: IL 018.001932) |
| Enumeration Date | 2014-11-05 |
| Last Update Date | 2020-02-17 |