NPI | 1407296718 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401414771) |
Additional Taxonomies | 122300000X Dentist (Licence: VA 0401414771) |
122300000X Dentist (Licence: IL 019029496) | |
Enumeration Date | 2013-07-01 |
Last Update Date | 2018-06-19 |