| NPI | 1972129427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 019.035975) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 105787) |
| Enumeration Date | 2020-06-21 |
| Last Update Date | 2025-08-06 |