| NPI | 1528495793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: AZ D009678) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019029634) |
| Enumeration Date | 2013-10-03 |
| Last Update Date | 2018-07-19 |