| NPI | 1770193971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: IL 019032643) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.032643) |
| Enumeration Date | 2020-08-03 |
| Last Update Date | 2025-07-31 |