NPI | 1124732565 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: IL 019034975) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
122300000X Dentist (Licence: LA 7501) | |
Enumeration Date | 2023-01-10 |
Last Update Date | 2024-08-05 |