| NPI | 1578544300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 102156) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 25986) |
| 122300000X Dentist (Licence: IL 019-025709) | |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2024-08-06 |