| NPI | 1063965986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 106765) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019.030852) |
| Enumeration Date | 2016-07-27 |
| Last Update Date | 2021-09-24 |