NPI | 1679556500 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: IL 019-017911) |
Additional Taxonomies | 122300000X Dentist (Licence: WI 5227-015) |
Enumeration Date | 2005-11-23 |
Last Update Date | 2007-07-08 |