| NPI | 1275093775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 019.032173) |
| Additional Taxonomies | 261QS1000X Clinic/Center, Student Health (Licence: IL 019.032173) |
| Enumeration Date | 2019-03-21 |
| Last Update Date | 2023-06-14 |