NPI | 1366002289 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019.033460) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901600179) |
Enumeration Date | 2019-06-13 |
Last Update Date | 2025-06-26 |