| NPI | 1669634846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: UT 6940132-9922) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: IL 019.029036) |
| Enumeration Date | 2008-06-27 |
| Last Update Date | 2015-12-25 |