NPI | 1740664333 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IL 019030594) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 64639) |
Enumeration Date | 2015-07-14 |
Last Update Date | 2016-05-09 |