| NPI | 1639800261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 111157) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019.033812) |
| Enumeration Date | 2022-06-23 |
| Last Update Date | 2025-04-22 |