NPI | 1558430207 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: CA 55840) |
Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: IL 019026323) |
Enumeration Date | 2006-11-07 |
Last Update Date | 2013-10-19 |