NPI | 1841605136 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: MD 16214) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019029835) |
Enumeration Date | 2014-06-25 |
Last Update Date | 2017-04-20 |