| NPI | 1528026135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 22762) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019023599) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NM DD2900) | |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2020-04-21 |