| NPI | 1366235673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA DDS112142) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.035990) |
| Enumeration Date | 2025-05-28 |
| Last Update Date | 2025-08-02 |