NPI | 1083457709 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: MO 2024021020) |
Additional Taxonomies | 122300000X Dentist (Licence: IL 019035192) |
Enumeration Date | 2024-06-18 |
Last Update Date | 2024-06-18 |