| NPI | 1861948374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: IL 019.029966) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019029966) |
| Enumeration Date | 2016-08-26 |
| Last Update Date | 2020-01-02 |