| NPI | 1376761429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA DDS54345) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019-023417) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2016-06-17 |