NPI | 1811986250 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: FL DN 13668) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019-023321) |
Enumeration Date | 2005-10-18 |
Last Update Date | 2022-06-24 |