| NPI | 1457459521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: MN S 21) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: IL 019.014163) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2007-08-23 |