| NPI | 1215310826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: TX 39232) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019030319) |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2022-12-28 |