| 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 |