| NPI | 1356749311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019.033541) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 63548) |
| Enumeration Date | 2014-12-08 |
| Last Update Date | 2022-06-21 |