| NPI | 1770562068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: MO 2002000301) |
| Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: IL 019025787) |
| Enumeration Date | 2006-01-13 |
| Last Update Date | 2017-01-26 |