| NPI | 1780771691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 019029262) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: HI 2223) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 52931) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WI 6965-15) | |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2013-09-12 |