| NPI | 1871879866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 61114) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 018001822) |
| Enumeration Date | 2011-10-23 |
| Last Update Date | 2023-05-02 |