| NPI | 1447811310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.034519) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 103832) |
| Enumeration Date | 2019-06-21 |
| Last Update Date | 2023-07-18 |