| NPI | 1508972340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 021.002165) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.025576) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2024-10-10 |