NPI | 1003043274 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208D00000X General Practice (Licence: IL 036.055709) |
Additional Taxonomies | 122300000X Dentist (Licence: IL 19.15068) |
Enumeration Date | 2009-06-16 |
Last Update Date | 2009-06-16 |