| NPI | 1679981096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019032206) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA 61272179) |
| 1223G0001X Dentist, General Practice (Licence: CA 63714) | |
| Enumeration Date | 2014-07-29 |
| Last Update Date | 2022-07-06 |