| NPI | 1417615386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.031809) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: IL 021.003144) |
| Enumeration Date | 2021-12-07 |
| Last Update Date | 2021-12-07 |