| NPI | 1902930159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NE 30317) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: IL 019-023700) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: IL 021-001773) | |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2018-03-17 |