| NPI | 1518857069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 111910) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019.036295) |
| Enumeration Date | 2025-07-07 |
| Last Update Date | 2026-03-19 |