NPI | 1639956758 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: IL 021.003290) |
Additional Taxonomies | 122300000X Dentist (Licence: IL 019.034585) |
Enumeration Date | 2023-09-12 |
Last Update Date | 2024-06-16 |