NPI | 1700197704 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: IL 019-029228) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019.029228) |
Enumeration Date | 2010-06-24 |
Last Update Date | 2021-04-26 |