NPI | 1871388181 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: IL 019.036145) |
Additional Taxonomies | 122300000X Dentist (Licence: IL 019.036145) |
Enumeration Date | 2025-04-09 |
Last Update Date | 2025-08-18 |