| NPI | 1336513050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA DDS106986) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.030513) |
| Enumeration Date | 2015-11-18 |
| Last Update Date | 2025-10-01 |