| NPI | 1780904144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 102032) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019-028287) |
| Enumeration Date | 2010-06-09 |
| Last Update Date | 2021-09-23 |