NPI | 1689886228 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019.025682) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 5295-015) |
Enumeration Date | 2007-05-04 |
Last Update Date | 2007-07-08 |