| NPI | 1982626248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NC 38955) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: IL 036071951) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NC 4061) | |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2012-12-28 |