NPI | 1720412992 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: TX 30087) |
Additional Taxonomies | 122300000X Dentist (Licence: IL 019029620) |
1223G0001X Dentist, General Practice (Licence: TX 30087) | |
Enumeration Date | 2013-08-24 |
Last Update Date | 2022-10-28 |