| NPI | 1962494633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA DDS103542) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: IL 019-022132) |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2023-02-01 |