| NPI | 1407036502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: CA A122601) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA OMS 101) |
| 122300000X Dentist (Licence: IL 019-027754) | |
| Enumeration Date | 2007-11-07 |
| Last Update Date | 2014-07-21 |