| NPI | 1306068192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: GA DNF000429) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: IL 019020381) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2020-02-06 |