| NPI | 1891775078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 53546) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: IL 019-023415) |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2016-08-16 |