NPI | 1306460845 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223D0001X Dentist Dental Public Health (Licence: IL 019-032602) |
Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: IL 019-032602) |
Enumeration Date | 2020-06-01 |
Last Update Date | 2020-07-22 |