NPI | 1629068523 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401410983) |
Additional Taxonomies | 122300000X Dentist (Licence: IL 019026095) |
Enumeration Date | 2005-10-24 |
Last Update Date | 2019-10-09 |