| NPI | 1043628506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 103210) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.029972) |
| 122300000X Dentist (Licence: WA DE60636134) | |
| Enumeration Date | 2014-07-29 |
| Last Update Date | 2024-05-15 |