| NPI | 1689494965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 110932) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019.035463) |
| Enumeration Date | 2024-10-12 |
| Last Update Date | 2024-10-12 |