NPI | 1801009337 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: IL 019-020325) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019-020325) |
Enumeration Date | 2007-05-08 |
Last Update Date | 2021-04-21 |