| NPI | 1225685183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.032358) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: CA DDS108485) |
| 1223P0700X Dentist, Prosthodontics (Licence: NV S5-60C) | |
| Enumeration Date | 2019-08-24 |
| Last Update Date | 2024-10-29 |