| NPI | 1144697723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA DDS101146) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.030437) |
| Enumeration Date | 2015-08-30 |
| Last Update Date | 2017-04-03 |