| NPI | 1457836843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: TX 34640) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: IL 019030279) |
| Enumeration Date | 2018-10-01 |
| Last Update Date | 2018-10-01 |