NPI | 1366879728 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: CO 00202761) |
Additional Taxonomies | 122300000X Dentist (Licence: IL 019029653) |
Enumeration Date | 2013-10-01 |
Last Update Date | 2016-09-02 |