| NPI | 1215075577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: IL 021002123) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019025795) |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2016-10-05 |