NPI | 1861780181 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 63123) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019028778) |
Enumeration Date | 2011-07-20 |
Last Update Date | 2019-10-10 |