| NPI | 1821261561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 58183) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.027390) |
| Enumeration Date | 2008-04-02 |
| Last Update Date | 2016-10-24 |