| NPI | 1770922429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 103653) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019029420) |
| Enumeration Date | 2013-06-17 |
| Last Update Date | 2019-12-24 |