| NPI | 1477532190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 54812) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 19025860) |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2007-07-13 |