NPI | 1336509900 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: WI 1001536-15) |
Additional Taxonomies | 122300000X Dentist (Licence: IL 019.031386) |
122300000X Dentist (Licence: AZ 9614) | |
122300000X Dentist (Licence: TX 33401) | |
Enumeration Date | 2016-02-25 |
Last Update Date | 2019-10-01 |