| NPI | 1518944099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: PR 3324) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019022032) |
| 1223G0001X Dentist, General Practice (Licence: PR 3324) | |
| Enumeration Date | 2005-12-27 |
| Last Update Date | 2024-09-25 |