| NPI | 1932735214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 019.033056) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 018.002137) |
| Enumeration Date | 2020-03-18 |
| Last Update Date | 2021-11-01 |