| NPI | 1538875794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 108556) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.033997) |
| Enumeration Date | 2023-01-30 |
| Last Update Date | 2023-05-03 |