| NPI | 1144423963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 019.027879) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: OH 2422) |
| Enumeration Date | 2007-06-08 |
| Last Update Date | 2009-07-23 |