| NPI | 1790345262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: IL 019032240) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019032240) |
| Enumeration Date | 2019-06-17 |
| Last Update Date | 2025-06-23 |