| NPI | 1811399892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: FL DN21711) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019029980) |
| 1223G0001X Dentist, General Practice (Licence: IL 019029980) | |
| Enumeration Date | 2014-09-21 |
| Last Update Date | 2021-10-26 |