| NPI | 1497993026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.027866) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: IL 019027866) |
| 122300000X Dentist (Licence: WI 6468115) | |
| Enumeration Date | 2009-02-04 |
| Last Update Date | 2010-09-13 |