| NPI | 1881949923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: IL 021.002698) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.030154) |
| Enumeration Date | 2012-07-16 |
| Last Update Date | 2017-01-23 |