| NPI | 1730636267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CA 108875) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.030683) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: IL 019.030683) | |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2024-07-02 |