| NPI | 1578009007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 35973) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019031547) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0401415475) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 021002865) | |
| Enumeration Date | 2017-01-08 |
| Last Update Date | 2020-03-25 |