Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DN21695 | FL |
NPI | 1073923017 |
---|---|
Provider Name | Avraham Amsalem |
First Address | Boca Raton, FL 33433-4125 |
Second Address | Delray Beach, FL 33484-6595 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2014 |
Last Update Date | 08/06/2021 |