| NPI | 1861780181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA 63123) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: IL 019028778) |
| Enumeration Date | 2011-07-20 |
| Last Update Date | 2019-10-10 |