| NPI | 1871117507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 106321) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.032607) |
| Enumeration Date | 2020-05-28 |
| Last Update Date | 2022-03-30 |