NPI | 1407867252 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MT 2112) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019-025870) |
1223G0001X Dentist, General Practice (Licence: MO 2002015202) | |
Enumeration Date | 2006-08-10 |
Last Update Date | 2007-07-08 |