| NPI | 1093736761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019-023025) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 53501) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2019-01-05 |