| NPI | 1972343135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 110325) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019035003) |
| Enumeration Date | 2024-05-27 |
| Last Update Date | 2024-07-16 |