| NPI | 1366823262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.033851) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 31017) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: IL 019.033851) | |
| Enumeration Date | 2015-06-16 |
| Last Update Date | 2023-08-26 |