| NPI | 1073916789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 100212) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.030065) |
| Enumeration Date | 2014-10-08 |
| Last Update Date | 2024-03-13 |