| NPI | 1255567483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019027955) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA DDS100937) |
| Enumeration Date | 2009-06-02 |
| Last Update Date | 2022-03-08 |