| NPI | 1295902096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NJ DI02440600) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.026729) |
| Enumeration Date | 2008-05-12 |
| Last Update Date | 2024-06-06 |