NPI | 1821071804 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 5774-15) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019026610) |
Enumeration Date | 2005-11-23 |
Last Update Date | 2022-07-21 |