| NPI | 1700131588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 63221) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019029111) |
| Enumeration Date | 2012-07-18 |
| Last Update Date | 2016-03-09 |