| NPI | 1962612622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 55913) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 55913) |
| 122300000X Dentist (Licence: IL 018001594) | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2021-04-15 |