| NPI | 1558430207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: CA 55840) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: IL 019026323) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2013-10-19 |