| NPI | 1568916856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 019.030866) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.030866) |
| Enumeration Date | 2016-08-04 |
| Last Update Date | 2026-08-04 |