NPI | 1386741858 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: AZ D5550) |
Additional Taxonomies | 122300000X Dentist (Licence: IL 019025258) |
122300000X Dentist (Licence: MN D11625) | |
Enumeration Date | 2006-09-19 |
Last Update Date | 2012-10-05 |