NPI | 1699349118 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2021017794) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019033253) |
Enumeration Date | 2021-05-19 |
Last Update Date | 2021-06-24 |