NPI | 1518155191 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 102569) |
Additional Taxonomies | 122300000X Dentist (Licence: IL 019027328) |
Enumeration Date | 2007-10-09 |
Last Update Date | 2022-03-16 |