| NPI | 1396188116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OK 212) |
| Additional Taxonomies | 122300000X Dentist (Licence: OK 7232) |
| 122300000X Dentist (Licence: IL 019029472) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-10 |
| Last Update Date | 2019-07-12 |