NPI | 1659455772 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: MA DF11247) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 136-000107) |
Enumeration Date | 2006-10-25 |
Last Update Date | 2017-03-30 |