| NPI | 1922065168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 019-023965) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OH 30013888) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NE 5756) | |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2013-03-18 |