| NPI | 1992760607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: WA DE00007197) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: IL 019-021543) |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2016-01-28 |