| NPI | 1538836556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: GA DNF000448) |
| Additional Taxonomies | 1223P0700X Dentist Prosthodontics (Licence: IL 019.032958) |
| Enumeration Date | 2021-08-26 |
| Last Update Date | 2023-04-13 |