| NPI | 1316477524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MD 17982) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.031142) |
| 171000000X Military Health Care Provider (Licence: IL 019.031142) | |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2024-10-09 |