| NPI | 1225228638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: CA GA1553) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019-026447) |
| 122300000X Dentist (Licence: CA 59990) | |
| Enumeration Date | 2007-08-01 |
| Last Update Date | 2013-05-17 |