NPI | 1740306414 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 25071) |
Additional Taxonomies | 122300000X Dentist (Licence: IL 019026108) |
Enumeration Date | 2007-03-22 |
Last Update Date | 2011-01-11 |