| NPI | 1700040219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0401413132) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS038063) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 019.027279) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0438000286) | |
| Enumeration Date | 2008-07-14 |
| Last Update Date | 2025-07-08 |